Candidate: Maria L Alcaide received her medical degree from The Universidad Autonoma de Madrid, Spain and completed her Internal Medicine residency and Fellowship in Infectious Diseases at Jackson Memorial Hospital in Miami. She is Assistant Professor of Medicine at the Division of Infectious Diseases at the University of Miami Miller School of Medicine. Mentors: Dr. Deborah Jones is Research Associate Professor in the Department of Psychiatry & Behavioral Sciences at the University of Miami Miller School of Medicine with extensive experience in behavioral research interventions to reduce sexual risk in HIV infected men and women domestically and internationally. Dr. Fischl is Professor of Medicine at the University of Miami Miller School of Medicine and an acknowledged world leader in the field of HIV clinical research. Drs. Jones and Fischl both have extensive mentorship experience and will ensure the success of Dr. Alcaide's training, proposed studies and career development. Research: Intravaginal practices (VP) are common among women in sub-Saharan and implicated in the development of bacterial vaginosis (BV) and HIV transmission. Building on pilot study results from Zambia obtained by Dr. Alcaide (R01HD058481S~ Alcaide et al., 2011), this study will develop and test a bio-behavioral intervention designed to decrease VP. The pilot study tested a bio-behavioral intervention and results support its effectiveness in reducing both VP and BV over 8 weeks. The current proposal will evaluate the long term impact of a bio-behavioral intervention targeting VP among HIV infected women in Lusaka, Zambia, and assess the relative contribution of VP and BV to genital inflammation and HIV shedding. Aim 1.1 will develop and evaluate the long term impact of a bio-behavioral intervention to decrease VP. Aim 1.2 will compare rates of BV, genital inflammatory markers and HIV shedding in HIV infected women engaging in VP with and without BV. Aim 1.3 will compare BV, genital inflammatory markers and HIV genital shedding in HIV infected women participating in the intervention or control conditions. This innovative bio-behavioral interventio designed to reduce VP has the potential to have a significant public health impact in the Zambian community and relevance for other sub-Saharan countries with high prevalence of both VP and HIV infection. The K23 award mechanism will allow Dr. Alcaide to obtain new skills in clinical and behavioral research, conduct a study of VP in Zambia, develop an R01 application with study results, and become established as an independent clinical investigator. PUBLIC HEALTH RELEVANCE: The long term goal of this proposal is to decrease transmission rates of HIV by decreasing the harmful behavior of intravaginal practices and the associated consequences such as bacterial vaginosis, genital inflammation and HIV shedding. Our results will clarify the pathway underlying the relationship between VP and HIV transmission and propose a bio-behavioral intervention to decrease VP.